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NPI Code Detail

MEDICARE: STEVEN CLARK KENNEDY MD

MEDICARE: STEVEN CLARK KENNEDY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician37194TN
2208600000XSurgery Physician072631GA

General Provider Information

NPI Number : 1376537001
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN CLARK KENNEDY MD
Provider Business Mailing Address
First Line : 4700 BATTLEFIELD PKWY STE 220
Second Line :
City : RINGGOLD
State : GA
Zip : 30736-5168
Country : US
Telephone Number : 423-698-8692
Fax Number : 423-624-7813
Provider Business Practice Location Address
First Line : 4700 BATTLEFIELD PKWY STE 220
Second Line :
City : RINGGOLD
State : GA
Zip : 30736-5168
Country : US
Telephone Number : 423-698-8692
Fax Number : 423-624-7813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 04/28/2022

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Directions to “ STEVEN CLARK KENNEDY MD” Practice Location

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